We have a 5 1/2 year old with Type 1 since age 2. She has started
kindergarten this year, and we are trying to figure out what could be the
best regimen for her insulin. Our physicians say we are doing fine, but we
still have problems, and are doing ok mainly because my wife goes to school
with her every day, and takes care of crises! (School personnel are willing to
help, but that is not the problem.)

The problem is that she gets N and R in the A.M., then R at dinner, N at night;
because of variable activity, food/snacks etc., she gets highs over 350,
lows in the 50's. No steady pattern to those numbers. Lows are easy to
treat, so far, since she actually is pretty aware, and gets glucose or
food. Highs are actually a big problem, because her behavior, normally
excellent, deteriorates rapidly. Again, one of us has been there, and
dealt with it, but that is not a tenable solution. We are not trying to be
too obsessive, but we are just trying to figure out a regimen, and get any
hints we can, on how people have coped with very young children in
school--in terms of what insulin regimens folks are using, food routines
etc. so that they can send their child to school with at least a
minimum of worry, and a child that will not have a lot of problems.

Answer:

Your problem is a common one and I think it's probably worth reiterating
the guiding principles of care of young children with diabetes. You cannot
expect or attempt to achieve perfect blood sugar control. This is
unrealistic in a child with very variable activity levels and food intake.

I am not in a position to offer you specific regimen advice but you need to
discuss this with your diabetes team. However, swings from high to low and
back again often suggest over insulinisation and I believe in keeping young
children's regimens as simple as possible. For most it's perfectly
reasonable to give twice daily injections. You certainly need to extricate
yourselves from regular attendance at school as soon as possible because
this is definitely detrimental to her development of any sense of
independence from home.

Last Updated: Tuesday April 06, 2010 15:08:56
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